Keto Diet And Ketoacidosis: What's The Real Link?

Ketosis and ketoacidosis are two different conditions that are often confused with each other due to their similar names. Ketosis is a metabolic state in which the body uses fat instead of glucose as fuel, and it is generally safe. On the other hand, ketoacidosis is a life-threatening complication of type 1 and, rarely, type 2 diabetes. It occurs when the body doesn't have enough insulin, causing a dangerous buildup of ketones and acid in the blood, making it too acidic. While ketosis can be a safe and effective way to lose weight for those without diabetes, ketoacidosis is a medical emergency that requires immediate care and can lead to death if left untreated.

Ketosis vs ketoacidosis

Ketosis is a metabolic process that occurs when the body breaks down fat for energy because it does not have enough carbohydrates. It can be induced by following a ketogenic diet, which involves eating high-fat, very-low-carb foods. It can also be induced by fasting or taking certain supplements. Ketosis is generally safe and is often used for weight loss.

Ketoacidosis is a life-threatening complication of diabetes, typically Type 1 diabetes. It occurs when insulin levels drop dangerously low, resulting in a buildup of ketones and acid in the blood. This causes the blood to become too acidic, which can affect the function of internal organs. Ketoacidosis is considered a medical emergency and requires immediate treatment.

Symptoms

Symptoms of ketosis may include bad breath, fatigue, muscle aches, and headaches. In contrast, ketoacidosis can cause more severe symptoms such as fruity-smelling breath, confusion, and difficulty paying attention. If left untreated, ketoacidosis can lead to loss of consciousness.

Causes

Ketosis is typically caused by a low-carbohydrate diet or fasting, while ketoacidosis is usually triggered by poor diabetes management, illness, infection, or certain medications. It can also be caused by factors such as drug misuse, traumatic injury, or alcohol use disorder.

Diagnosis and Treatment

Both ketosis and ketoacidosis can be diagnosed through blood or urine tests that measure ketone levels. While ketosis does not require treatment, ketoacidosis requires urgent medical attention. Treatment for ketoacidosis involves fluids, electrolytes, and insulin therapy, along with addressing any underlying causes.

Ketogenic diets and ketoacidosis

The ketogenic diet is a nutritional regimen that involves eating a low amount of carbohydrates, a high amount of fat, and an adequate amount of protein. The body is put into a state of ketosis, where it uses fat instead of glucose as fuel. This diet has been used to treat seizure disorders and neurodegenerative disorders, and has become popular for weight loss.

Ketosis is generally safe, but in some cases, it can lead to ketoacidosis, a life-threatening condition. Ketoacidosis occurs when the body produces dangerously high levels of ketones, which can cause the blood to become too acidic. This is often a complication of type 1 diabetes, but it can also occur in people with type 2 diabetes or even those without diabetes who are following a strict ketogenic diet.

Triggers for Ketoacidosis

• Poor diabetes management, such as missing insulin doses or not receiving the correct amount
• Illness or infection that prevents the body from using insulin properly
• Fasting and malnutrition, especially in people with a history of excessive alcohol consumption
• Drug misuse, especially cocaine
• Acute major illnesses such as sepsis, pancreatitis, or myocardial infarction
• Traumatic injuries, such as from a car accident
• Certain medications, including water pills and anti-inflammatories

Symptoms of Ketoacidosis

• Fruity-smelling breath
• Feelings of confusion
• Fast, labored breathing
• Muscle stiffness or aches
• High blood glucose levels
• Rising levels of ketones in the urine
• Thirst and frequent urination
• Loss of consciousness

Treatment and Prevention of Ketoacidosis

Ketoacidosis is a medical emergency that requires immediate treatment. Treatment typically involves insulin therapy, fluid replacement, and electrolyte replacement in a hospital or emergency room setting.

To prevent ketoacidosis, people with diabetes should monitor their blood glucose levels regularly and notify their doctor if they are not under control. They should also test their urine for ketones if blood glucose levels are above 240 mg/dL and avoid exercise if ketones are present in the urine and blood glucose levels are high.

Ketogenic Diet Considerations

The ketogenic diet is extremely low in plant-based foods, which can reduce the intake of important nutrients such as fiber, vitamins, minerals, antioxidants, and polyphenols. It can also be challenging to maintain due to its restrictive nature, and it may have adverse effects on the gut microbiome over time.

While the ketogenic diet can be effective for weight loss, it is important to be aware of the risks associated with it, particularly the potential for ketoacidosis. People with diabetes or other health conditions should consult their doctors before starting this or any other extreme diet.

Diabetic ketoacidosis

People with type 1 diabetes are most often diagnosed with diabetic ketoacidosis because their bodies do not produce insulin. In rare cases, it may also occur in people with type 2 diabetes, where the body either does not make enough insulin or the insulin does not work properly. Poor diabetes management is a leading trigger for diabetic ketoacidosis. In people with diabetes, missing insulin doses or not receiving the right amount of insulin can lead to this condition.

Additionally, illnesses or infections, and certain drugs can prevent the body from using insulin properly, leading to diabetic ketoacidosis. Other triggers include fasting and malnutrition, drug misuse, particularly cocaine, and acute major illnesses such as sepsis, pancreatitis, or myocardial infarction. It is important to note that diabetic ketoacidosis can also be the first sign of diabetes in some cases.

The symptoms of diabetic ketoacidosis include high blood glucose levels, rising levels of ketones in the urine, thirst, frequent urination, a fruity odour in the breath, confusion, difficulty paying attention, and loss of consciousness. If left untreated, it can progress quickly and cause serious health complications, so prompt treatment is critical.

The treatment for diabetic ketoacidosis typically involves hospitalisation, insulin therapy, fluid replacement, and electrolyte replacement. Most people with this condition will need to be monitored in a hospital until their blood ketone levels return to normal.

To prevent diabetic ketoacidosis, people with diabetes should monitor their blood glucose levels regularly and notify their doctor if they are not under control. They should also test their urine for ketones if their blood glucose levels are above 240 mg/dL and avoid exercise if ketones are present in the urine and blood glucose levels are high. Taking insulin as directed by a doctor and maintaining a healthy and balanced diet are also crucial in preventing this condition.

Ketoacidosis symptoms

Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening condition that can lead to a diabetic coma or even death. It is a complication of diabetes, most commonly type 1, but it can also occur in people with type 2 diabetes, albeit rarely.

DKA occurs when the body doesn't have enough insulin to allow blood sugar into the cells for energy. As a result, the body starts breaking down fat for energy, which produces chemicals called ketones. When ketones build up in the blood, they make it more acidic, and at high levels, they can be poisonous.

DKA usually develops slowly, but when vomiting occurs, it can progress to a life-threatening condition in just a few hours. Early symptoms of DKA include:

• Thirst or a very dry mouth
• High blood glucose (blood sugar) levels
• High levels of ketones in the urine

As the condition progresses, other symptoms may appear, such as:

• Constant fatigue
• Nausea, vomiting, or abdominal pain
• Difficulty breathing
• Fruity odour on breath
• Difficulty paying attention or confusion

If you are experiencing any of these symptoms, it is important to contact your healthcare provider immediately or go to the nearest emergency room.

To prevent DKA, it is important to monitor your blood sugar levels regularly, especially if you are sick, and take your medications as prescribed. If your blood sugar levels are above 240 mg/dL, it is recommended to test for ketones using a urine test strip or a blood glucose meter.

Ketoacidosis treatment

Diabetic ketoacidosis is a medical emergency that can be life-threatening but is also highly treatable. Treatment usually takes place in a hospital or emergency room and involves insulin therapy together with fluid and electrolyte replacement.

Fluid Replacement

The first step in treating ketoacidosis is to replace lost fluids through urination. Fluids can be given by mouth or intravenously. When given through a vein, they are called IV fluids.

Electrolyte Replacement

The next step is to replace electrolytes such as chloride, sodium, or potassium. Electrolytes are minerals in the blood that carry an electric charge. Too little insulin can lower the level of several electrolytes in the blood, so IV electrolytes are given to help keep the heart, muscles, and nerve cells functioning properly.

Insulin Therapy

Insulin is typically administered intravenously and works to reverse ketoacidosis. In addition to fluids and electrolytes, insulin is given until the blood sugar level falls to about 200 mg/dL (11.1 mmol/L) and the blood is no longer acidic.

Monitoring

Most people with diabetic ketoacidosis will need to stay in the hospital for monitoring. As blood ketone levels return to normal, the doctor may recommend additional testing to determine if the patient has other risk factors for ketoacidosis.

Prevention

Monitoring blood glucose levels can help prevent ketoacidosis. People with diabetes can reduce their risk by regularly monitoring blood glucose levels and notifying their doctor if they are not under control. They should also test their urine for ketones if blood glucose levels are above 240 mg/dL and avoid exercise if ketones are present in the urine and blood glucose levels are high.

It is important to eat a healthy and balanced diet, avoid skipping meals, and take insulin according to the doctor's treatment plan.

Frequently asked questions